Water, sanitation and hygiene: A foundation of strong, resilient health systems

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Climate change, Health
Village: Kachanahalli, Block: Nelamangala, District: Bangalore Rural, Karnataka, India. Pooja, 3 year, wash her hand alongwith other children on a hand wash station at Anganwadi in  Kochanahalli village, Karnataka, on 13 Nov, 2019.
WaterAid/Dhiraj Singh

Water, sanitation and hygiene (WASH) in healthcare facilities (HCF) is essential for providing quality care and preventing avoidable deaths. As the world faces climate change, epidemics and the ongoing COVID-19 pandemic, the need for climate-resilient, inclusive and sustainable WASH has never been more important. WASH in HCF services and behaviours need to be resilient to climate change, responsive to public health emergencies and fit to meet the diverse and changing needs of the population.

Lack of access to WASH has long undermined the quality and safety of services provided in HCF and set back progress towards universal health coverage (UHC). The COVID-19 pandemic has brought renewed focus on health systems and HCF, as well as highlighting gaps and inequalities globally. It has underlined that WASH services and behaviours in HCF are a prerequisite for infection prevention and control (IPC), for the safety of health service users and health workers, and fundamental for strong and resilient health systems that can deliver quality healthcare during times of crisis. We need to urgently address the WASH crisis in HCF to improve the quality of health services and behaviours, strengthen pandemic preparedness and create resilient health systems.

Where WASH does exist in HCF, it is often underperforming or poorly managed. Poor sustainability of WASH is likely to be worsened by climate change impacts, devastating health systems, interrupting routine services and overwhelming HCF infrastructure – including WASH. Strengthening the systems required to maintain and restore WASH in HCF is imperative to ensure frontline services can respond to, cope with, recover from and adapt to large public health emergencies and climate-related stresses.

This learning report is based on lessons emerging from our WASH in HCF work, across the countries in which we work. We share practical experiences of system strengthening for WASH in HCF and explore examples of where progress at the district and national level has been made. We hope that by capturing lessons learned and sharing approaches that have supported success, we will show where investment and action are required in order to achieve inclusive and sustainable access to WASH in all HCF. We have been working with ministries of health (MoH) and partners to improve WASH in HCF in more than twenty countries – in some cases for more than a decade.